Performance measurement in the U.S. health care system has expanded dramatically over the past 30 years. The National Quality Measures Clearinghouse now lists more than 2500 performance measures. These measures are used in various quality-reporting, accountability, and payment programs sponsored by commercial payers, government agencies, and independent quality-assessment organizations. The Centers for Medicare and Medicaid Services (CMS) aims to base 90% of Medicare fee-for-service payments to clinicians on “value” by the end of 2018 by using performance scores.

Although most physicians view the delivery of high-quality care as a professional imperative,1 performance-measurement activities face increasing resistance from physicians and some policymakers who believe that current measures are not meaningful.2 In a recent survey, 63% of physicians said that current measures do not capture the quality of the care that physicians provide.3 Yet U.S. physician practices are spending $15.4 billion each year — about $40,000 per physician — to report on performance.………more